Gabe Grunewald on Running and Cancer Treatment: “I’m Not Throwing in the Towel”

During the past year, Gabriele Grunewald, 31, has tried to maintain her presence as a professional middle-distance runner while pursuing all available avenues to treat her fourth bout of cancer. It’s been a year of extensive travel, a lot of airports, and many hours in doctors’ offices.

All the while, Grunewald has openly shared her story about her life with adenoid cystic carcinoma, first diagnosed in 2009, when she was an NCAA standout at the University of Minnesota. Her latest recurrence came in March, seven months after she had a large tumor removed from her liver. More small tumors returned to her liver, which did not respond to chemotherapy and have not stabilized this fall during an immunotherapy clinical trial.

Splitting time between her hometown of Minneapolis and Memorial Sloan Kettering Cancer Center in New York, Grunewald and her husband, Justin Grunewald, have also taken time to visit Europe and, of course, run. Now the 2014 national champion in the 3,000 meters is eyeing an opportunity between treatments to focus more attention on her training—and hopefully qualify for the U.S. indoor track championships in February.

Runner’s World: Can you update us on the latest in your treatment? Last time we talked you had recently discovered that the chemo wasn’t effective, so you had started immunotherapy.

Gabriele Grunewald: Most recently I was on an immunotherapy clinical trial from middle of July until my last infusion on November 1. In October they decided they wanted to add some radiation treatment to help boost that immune response. That’s what I was prepping for in November. I had a treatment last Wednesday—it’s called stratosphere or Y90—it’s a liver-directed radiation treatment. They send these little, targeted glass beads of radiation through your femoral artery directly into the tumors in my liver. What my oncologist is hoping for is a synergistic effect between the immunotherapy and the radiation, to sort of boost the response we’re getting from my immunotherapy. It’s a one-and-done treatment, not like regular radiation where you might have five days a week. The radiation I got will release through the next few weeks, so I won’t have to go back and get another one, which is great.

GG: Since they go in through the femoral artery, you can get some swelling and bruising in that area, which I definitely experienced with the planning procedure in November. But this time around I didn’t get any of that. I feel pretty good. Fatigue is one of the only side effects, honestly, so that should resolve in the next few days.

I was able to run over the weekend, which was nice, even though I was tired. I definitely feel pretty normal. For the next four weeks I won’t have any treatments—I may have some imaging in January. They want to see how this works. I’ll go back on some form of immunotherapy in January. That’s my treatment plan right now. I’m pretty much on this plan for the next two or three months. I don’t really know beyond that. I’m hoping this works.

Immunotherapy was not stabilizing my disease. That’s why they needed to add this treatment. Even in January it’ll be too soon to tell what kind of response this radiation treatment has created, because you can get inflammation, which doesn’t really show what’s going on. I probably won’t know how this treatment works until sometime in February.

RW: How do you feel, physically?

GG: I feel normal, which I wasn’t expecting. They did this procedure [in November], which is the exact same thing [as last week] through the femoral artery. It’s a liver mapping they do. I don’t think I ran for six or seven days after that because I bruised a lot and had swelling. It goes away and I was fine after a week. I was expecting the same thing last week, but it didn’t happen this time. I’m taking it easy with running, but there’s not any real risk for me to be running right now. I’m trying to listen to my body, but I’m good to run.

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RW: You mentioned that one of your doctors is a runner. Does that help at all?

GG: My interventional radiologist at the Mayo Clinic is a runner. I first met with him in April. He looked at my case a little differently because he understands my job and what my body requires to be a runner. It was pretty cool to have him as my doctor because from the beginning he was trying to figure out how they could be minimally invasive. Going in through the femoral artery is a big deal if you’re a runner, so he was trying to find way to tweak the procedure so it impacts my running minimally, like using a small needle or whatever it is that they use to get in. A lot of times they will put a star clamp on after the puncture of the artery because it heals quicker, but the clamp is a permanent thing. He was like, “No, we’re not putting this clamp on.” If you have it, you have to lay flat for two hours after the procedure. He said that they weren’t using one on my artery because of my running, so I had to lay flat for four hours. It was cool because he knows I want to get back out there and be active. He did a really good job. I got home and didn’t feel any pain or discomfort. I’m hoping I can get a run in with him some day. He’s a cool guy.

RW: You’ve had a difficult year. I’m wondering how do you feel mentally and emotionally?

GG: I feel like this year has been very challenging mentally—even more so than physically. I can bounce back from almost anything physically, but mentally it has been a tough year. I’m doing fine. I’m just sort of getting used to my new normal, which is getting used to life in two-to three-month increments and still hoping to find something that stabilizes my disease. Or, even better, gets rid of some of it. I focus on the fact that I still feel good and basically still symptom-free. My liver is still functioning normally. Those are all good things. I think the most frustrating thing is that trying to remain an elite runner has been hard because I’ve had a lot of interruptions in training. But despite those interruptions, I’ve gotten in decent shape this fall in base training. I’m starting to get to the point where there is some racing on the schedule that I think I can fit in and I’d like to do. It makes me more excited about the next few months. I’m just trying to take my life in these shorter increments and fit in what I can. I’m getting a little bit better at it, but I still have days that are tough.

RW: What are some of your goals for running this winter?

GG: My training has been casual but I’ve still been trying to get it in. My objective is to fit in what I can with what my body allows and the timing. I think I will feel good enough and have a little bit of a window here to do some more intense training. My goal is to run two or three indoor track races. I’m just going to get on the indoor track at the end of this week and try to figure out where I’m at fitness-wise. I haven’t been doing anything specific. I’ve been doing long runs and mile repeats and hills, but that’s all. I’m not signed up for any meets now. I’m going to take the month of December to get into some harder workouts and see what’s realistic. If everything goes well I’d like to do some races at the end of January or early February—maybe a mile and a 3K. If I qualify for indoor [national championships] that would be a good place for me to get back into competitive racing since I was not really able to be competitive at USAs last year. It would be fun to see what I could do in Albuquerque. I don’t know which event—I’m just going to see how my training goes and figure it out.

RW: You’ve also posted some pictures of what looked like a fun European adventure. What were the highlights?

GG: I got invited to the [International Association of Athletics Federations] awards in Monaco. My husband and I decided to make the trip and if we were going all the way there we may as well stay for a while. We had a good time. We hung out in Monaco for a few days, then we went to Switzerland in the Jungfrau region, which is the highest elevation in Europe. We hung out in a town called Grindelwald, which is in the mountains. It was really snowy and icy, so we took the train down to Interlaken and do some running where it wasn’t full-on winter. My husband really enjoyed that—we had fun there, just exploring and hanging out. We ended in Paris, which is fun for me. I like to explore cities more than my husband. We had a good balance of things, but we were totally ready to come home at the end. My husband had only been to Europe once—he went to Poland when I ran in the world indoor track championships, so I felt like I owed him more than Poland. So, we had fun. We got some training in, too.

RW: You’ve talked a lot about hope. What does that mean to you right now and into the new year?

GG: Hope is so important—hope for health and my future is something I need to get through every day. I’m at the point that I’ve got through some treatments that haven’t worked great and it gets discouraging. For me to hang in there, I have to believe that something is going to work for me. Having so many doctors working on my case and wanting to help me, it helps me to stay positive. Each time I can do a different treatment or a different strategy, it can either be discouraging or it can be positive and I can be grateful there are so many medical professionals trying to find something that works for me. I really feel like if all these people are trying to help me, I’m not going to throw in the towel, I’m going to hang in there and stay positive. That will help my outcome overall anyway. Throughout all of it, I believe something will work for me eventually. In the meantime, I gotta live my life.

GG: I think I’ve traveled more this year than I have any other year—that’s what it has felt like. I don’t have any flights on the calendar for the first time in a long time. Our families are all here in Minnesota, so we’re going to stay here and enjoy not being in an airport for a while. I’m excited because I’m really going to try to hit the indoor track and focus on getting training in. I have this window of time here that I can actually focus on my training and I haven’t had that in a while. Most people are the opposite over the holidays, but I’m ready to start working hard and seeing how fit I can get this winter. But, we’re going to relax and cook good food and do some fun winter activities. There’s probably some ice fishing in my future. We’ll have people over—our siblings and parents—and we’ll just be cozy and be warm when we’re not running outside.

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